Mortality Burden and Socioeconomic Status in India

Abstract

BackgroundThe dimensions along which mortality is patterned in India remains unclear. We examined the specific contribution of social castes, household income, assets, and monthly per capita consumption to mortality differentials in India.Methods and FindingsCross-sectional data on 217 363 individuals from 41 554 households from the 2004–2005 India Human Development Survey was analyzed using multiple logistic regressions. Mortality differentials across social castes were attenuated after adjusting for household economic factors such as income and assets. Individuals living in the lowest income and assets quintiles had an increased risk of mortality with odds ratio (OR) of 1.66 (95% CI = 1.23–2.24) in the bottom income quintile and OR of 2.94 (95% CI = 1.66–5.22) in the bottom asset quintile. Counter-intuitively, individuals living in households with lowest monthly consumption per capita had significantly lower probability of death (OR = 0.27, 95% CI = 0.20–0.38).ConclusionsMortality burden in India is largely patterned on economic dimensions as opposed to caste dimensions, though caste may play an important role in predicting economic opportunities.

A Systematic Review of the Literature on the Relationship between Caste Membership and Health-Related Risk Factors in India

“…Mortality accessed in three studies reported odd ratios (OR) varying from 1.08 to 1.94. 19,22,12 Po and Subramanian (2011) reported significantly higher odds of mortality in Other Backward Classes (OBC), Scheduled Castes (SC), and Scheduled Tribes (ST). 19 However, after adjusting for wealth factors such as income, assets, and consumption per capita, the associations were no longer statistically significant with the exception of Scheduled Castes (OR = 1.72, 95% CI = 1.23-2.41).…”

“…19,22,12 Po and Subramanian (2011) reported significantly higher odds of mortality in Other Backward Classes (OBC), Scheduled Castes (SC), and Scheduled Tribes (ST). 19 However, after adjusting for wealth factors such as income, assets, and consumption per capita, the associations were no longer statistically significant with the exception of Scheduled Castes (OR = 1.72, 95% CI = 1.23-2.41). Adjusting the effect of caste on mortality with household income and asset ownership independently also resulted in the attenuation of caste effect on mortality except in Scheduled Castes as mentioned above.…”

Demographic Convergence and its Linkage with Health Inequalities in India

“…The previous empirical research has established a strong connection between 'international income inequality and inequality in health'. The studies have shown that common indicators of population health such as life expectancy and infant mortality are strongly correlated with average income levels, such that richer countries enjoy better health (Preston, 1975;Deaton, 2004;Subramanian et al, 2006Subramanian et al, , 2009Harper and Lynch, 2007;Van de Poel et al, 2008;Subramanian, 2008;Speybroeck et al, 2009;Konda et al, 2009;Po and Subramanian, 2010). Also, the evidence from trends in health inequalities-in both the developing and developed world-supports the notion that health inequalities rise with rising per capita income.…”

“…Though, socioeconomic status and health outcomes, health inequalities relationship are well established (Wagstaff and Doorslaer, 1991;Kakwani et al, 1997;Gwatkin, 2000;Kawachi et al, 2002;Wagstaff, 2002aWagstaff, , 2002bMormot, 2002;Van Doorslaer and Gerdtham, 2003;Wagstaff et al, 2003;Mackenbach, 2003;Van Doorslaer et al, 2004;Subramanian and Kawachi, 2004;Hosseinpoor et al, 2006;Subramanian et al, 2006Subramanian et al, , 2009Harper and Lynch, 2007;Van de Poel et al, 2008;Subramanian, 2008;Speybroeck et al, 2009;Konda et al, 2009;Po and Subramanian, 2010;Pradhan and Arokisamy, 2010;Marmot, 2005Marmot, , 2010Po and Subramanian, 2011;Arokiasamy et al, 2012;Suzuki et al, 2012), but there are not many studies which have examined the relationship between the demographic and health transition with transition health inequalities. In particular, the question 'Does socioeconomic, demographic and health progress is leading to greater uniformity in average health status or health inequalities are swimming against the tide' is not given much attention.…”

“…Health inequalities have recently started to receive a good deal of attention in the developing world. They are recognized to be a major problem in all countries studied (Subramanian et al, 2006Harper and Lynch, 2007;Van de Poel et al, 2008;Subramanian, 2008;Speybroeck et al, 2009;Konda et al, 2009;Po and Subramanian, 2010). The evidence from trends in health inequalities in both the developing and developed world supports the notion that health inequalities rise with rising per capita incomes (Wagstaff and Doorslaer, 1991;Kakwani et al, 1997;Gwatkin, 2000;Kawachi et al, 2002;Wagstaff, 2002aWagstaff, , 2002bMormot, 2002;Wagstaff et al, 2003;Mackenbach, 2003;van Doorslaer et al, 2004;Subramanian and Kawachi, 2004;Hosseinpoor et al, 2006;Pradhan and Arokisamy, 2010;Marmot, 2005Marmot, , 2010van Bon-Martern et al, 2012;Arokiasamy et al, 2012;Suzuki et al;.…”